Pediatric Hydrops Fetalis Differential Diagnoses

Updated: Jan 09, 2014
  • Author: Ashraf H Hamdan, MD, MBBCh, MSc, MRCP, FAAP; Chief Editor: Ted Rosenkrantz, MD  more...
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DDx

Diagnostic Considerations

Important considerations

Unique medicolegal issues primarily concern the difficult access to the fetus.

The keystone of management of hydrops fetalis is developing parental knowledge and understanding of all choices to obtain truly informed consent. Because the fetal condition is always urgent and time is short, development of this parental knowledge and understanding may represent a considerable challenge.

Medications given to the mother place her at risk; however, the same medications may ultimately reach the fetus in concentrations too low to be effective. In addition, a standard therapy has yet to be established.

The option of direct fetal access for drug administration has often been used; however, the invasive methods used inevitably place both mother and fetus at increased risk.

Similarly, direct fetal surgical maneuvers carry more risk for the fetus than similar procedures performed after birth; direct fetal surgical maneuvers also place the mother at increased risk.

Finally, inadvertent harm to the fetus places the clinician at medicolegal risk for a considerably longer period than is usual.

Special considerations

Mirror syndrome is a rare entity characterized by maternal disease that mimics fetal hydrops. [24] In mirror syndrome, maternal hypertension, edema, and often proteinuria are present in association with fetal hydrops.

Mirror syndrome is reported with various conditions associated with hydrops fetalis and is life threatening to both the mother and fetus if unnoticed and untreated. Prompt delivery is the treatment of choice.

The causal link between mirror syndrome and hydrops fetalis remains elusive.

Other problems to be considered

Consider the following in the evaluation of patients with suspected hydrops fetalis:

  • Hypoxic-ischemic brain injury in the newborn
  • Laryngeal stenosis
  • Pulmonary hypertension
  • Congenital heart disease
  • Prune-belly syndrome
  • Uncommon coagulopathies

Differential Diagnoses